Recovery From Schizophrenia: Psychiatry And Political Economy

286 DESEGREGATING SCHIZOPHRENIAtaking medication—usually around 50 per cent over the course of nine months.Patients receiving family therapy, however, experience relapse rates of under tenper cent. 45 If we look back to Figure 10.2, we may see that antipsychotic drugsreduce the rate of relapse for people with schizophrenia spending large amountsof time in high-stress households from a virtual certainty to a 50–50 chance. Nowwe see that family intervention can change the stress pattern of such a householdand almost eliminate the remaining risk (at least over a nine-month period).What are the elements of effective family therapy? In most studies the familyintervention is rather similar. In a study conducted by Julian Leff, for example, thefamily treatment comprised (a) a series of sessions of education about mentalillness, (b) participation in a relatives’ group and (c) individual family therapyconducted in the patient’s home. The relatives’ group, which was the centralcomponent of the program, offered support for the relatives, who often feltisolated and lonely; practical strategizing for those who were having troublecoping with difficult behavior; and role-playing to assist in the development ofnew attitudes. 46In his latest work, Dr Leff has been broadening the availability of familyinterventions for people with schizophrenia, by training community nurses andfamily members in Britain to provide the therapy to families. An organizationcalled Carer Education and Support (CESP), in cooperation with the NationalSchizophrenia Fellowship in Britain, has been training relatives of people withmental illness to provide education and support to the families of people withschizophrenia. 47 This approach is also proving successful in Boulder, Colorado,where members of the local chapter of the National Alliance for the Mentally Illand mental health staff run support and education groups.Many families of mentally ill people feel that ‘therapy’ implies pathology and,hence, blame, so non-stigmatizing approaches must be used. Education for thementally ill and their relatives, for example, can be provided as an evening class.Such courses have been run annually at the Mental Health Center of BoulderCounty for over 20 years, sponsored by local organizations of the mentally ill andtheir relatives. An outline of the topics for one series of classes is set out inTable 12.2. Such a course can be run at low cost, for the speakers may be drawnfrom among the agency consumers and staff and community professionals. For theteacher, the class is an agreeable experience; rarely does one encounter students sohungry for knowledge and so interested in the subject matter.For the students, the class is more than an educational program. On eachoccasion the course has been run, the participants have gained support from theinformal sharing of experiences—the recognition that they are not alone, thatother people have found strategies for the problems with which they have beenstruggling in isolation.